The P-Shot Treatment, or Priapus Shot, is a medical treatment aimed at addressing sexual dysfunction and enhancing sexual performance in men. This treatment has gained popularity as a potential solution for issues like erectile dysfunction (ED) or sexual performance problems. The primary component of P-Shot treatment involves injecting platelet-rich plasma (PRP) derived from the patient’s own blood into the penis.

Erectile dysfunction (ED, impotence) is one of the most common urological problems in men after the age of 50. In recent years, many new applications have been used in the treatment of impotence. One of them is PRP (P-shot) application to the penis. PRP application is one of the restorative or regenerative medicine applications. In this article, I will give current and general information about this issue in patients with erectile dysfunction.

Erection problem and what are its main causes?

Erectile dysfunction (erectile dysfunction, erectile dysfunction, ED, impotence) is defined as “the inability to achieve or maintain an erection sufficient for a normal sexual intercourse”. Today, thanks to the improvement in health standards and the prolongation of life expectancy, people can continue their sexuality until old age. ED can be a result of many systemic diseases, and it is a problem that we encounter in advanced ages. In recent years, many studies have been carried out in the field of regenerative medicine in the treatment of ED. One of them is PRP.

We can list the main conditions that cause erection problems (erectile dysfunction, ED) in men as follows:

• Diabetes
• Obesity (obesity, excess weight)
• Excessive alcohol and cigarette use
• High cholesterol
• Cardiovascular diseases
• Prostate cancer surgery (radical cystectomy (open, laparoscopic, robotic)
• Bladder cancer surgery (artificial bladder, ileal loop surgeries)
• Colon surgeries
• Some drugs used
• Old age
• Some neurological diseases
• A sedantary life
• Psychological reasons, excessive stress

What is Platelet Rich Plasma (P-Shot Treatment)?

Human blood consists mainly of 4 different parts: erythrocytes, leukocytes, platelets and plasma. Plasma is the liquid part of the blood and makes up about half of the blood. PRP is an expression created by taking the initials of the words Platelet Rich Plasma in English and translated into Turkish as “platelet rich plasma”. Platelets (thrombocytes) are blood cells found in normal people and responsible for blood clotting. After some blood taken from the patients is centrifuged at high speed, plasma and platelets are separated from other parts of the blood. This part containing a large amount of platelets is called “platelet-rich plasma, PRP”. Injecting the PRP obtained in this way into the penis is called Priapus Shot or P-Shot. In short, PRP means platelet-rich plasma prepared with special methods.

How is PRP obtained (prepared)?

The patient’s own blood taken from the arm vein is centrifuged at high speed in the tube with the help of the filters and centrifuge in the PRP preparation kit specially prepared for this process. The liquid (serum, plasma) obtained at the end of the centrifugation process contains intensely platelets (platelets) and many growth factors (PDGF, VEGF, TGF-α and TGF-β). Then, the obtained PRP portion is taken and injected into the penis with a thin needle.

Areas where PRP treatment is used in medicine

PRP treatment is used for treatment in some areas of medicine, especially in the cosmetic sector.

• Urology
• Orthopedics
• Dermatology
• Plastic surgery

PRP usage areas in urology

In urology, PRP is mostly applied to patients who have erection problems. It is generally used in the treatment of the following diseases in urology:

• Treatment of erectile dysfunction: In cases of erectile dysfunction due to organic causes, tissue loses its elasticity due to apoptosis (programmed cell death), fibrosis and increased connective tissue in smooth muscles in the structures of the penis responsible for erection, called the corpus cavernosum, resulting in erectile dysfunction. PRP treatment injected into cavernous bodies shows its effect by providing new vessel formation (angiogenesis), regeneration (tissue regeneration) and rejuvenation (tissue rejuvenation) in cavernous tissue.
• Peyronie’s disease
• Chronic prostatitis
• Chronic cystitis
• Interstitial cystitis
• Penis enlargement
• Increasing sexual performance

How does PRP work?

PRP shows its effect in the applied area thanks to the growth factors (growth factor) and many other effective molecules. The mechanisms of action can be listed as follows:

• Increase and regeneration of blood vessels occur
• Regeneration (regeneration, repair) occurs in nerves and other structures
• Tissue healing stimulating effect occurs
• Accelerates the development of existing tissues
• It provides tissue rejuvenation by stimulating the stem cells in the tissue (PRP is not a stem cell treatment).

The most recommended situation for PRP application regarding erectile dysfunction is erection problems that occur due to normal aging. PRP contributes to the improvement of erection by providing regeneration in the aging penis with the factors it contains.

The effects of PRP application on erection are as follows:

• An increase in blood flow is observed in the penis
• Improvement is provided in erection problem
• There is an increase in the effectiveness of drugs used in the treatment of ED (such as Viagra, cialis)
• There is improvement in the neural structures of the penis
• An increase in libido and penile sensitivity is observed.
• Synergistic effect is obtained with testosterone treatment
• It is claimed that an increase in penile length and diameter is observed.

How is P-Shot Treatment applied in the treatment of erectile dysfunction?

For patients with erection problems, PRP treatment is applied once a day, every other day, for a total of 3 sessions. Since it is suggested that the effectiveness of PRP treatment increases with maintenance treatments, it is considered appropriate to renew it as a single dose in the 3rd, 6th and 12th months. It takes approximately 35-45 minutes as blood collection, preparation and application of PRP.

The procedure is done with a thin insulin injector on the sides of the penis. Since the needle is very thin, patients feel a very slight pain, so there is usually no need to apply painkillers or analgesic creams can be applied to the injection area 5-10 minutes before the procedure. The patient returns to his daily activities after the procedure. There is no need to stay in the hospital, it is a procedure applied in practice conditions.

Can PRP treatment be applied simultaneously with ESWT treatment?

One of the frequently asked questions is whether PRP treatment and ESWT (shock wave therapy to the penis) treatment should be applied together. There are studies in the literature that PRP treatment can be performed simultaneously with ESWT. We also recommend such combined treatments to our eligible patients. Doing these two applications at the same time does not have any negative effects. Since their mechanisms of action are similar, they can increase each other’s effectiveness.

What are the complications of PRP treatment?

PRP injection into the penis has no serious complications. There may be minor problems that do not cause serious problems, these are:

• Mild pain at the injection site
• Swelling at the injection site (hematoma),
• Bruising at the injection site
• Infection can be seen

When does the effect of PRP start?

Penile PRPR application shows its maximum effect after 3 months. It is claimed that the effect of the treatment can be long-lasting or permanent. The effectiveness of the treatment is not the same for every patient. There are differences from patient to patient. The patient’s age, habits such as smoking and alcohol, obesity, diabetes, high blood pressure affect the response to treatment.

What should be considered in PRP application?

Some issues should be considered in patients who will undergo P-shot application. We can list them as follows:

• It should preferably be given 5-7 days after discontinuation of blood thinners in patients taking blood thinners.
• If there is an infection in the application area, it should be treated and then treated.
• Painkillers and anti-inflammatory agents should not be given for one day, as they will reduce the effect of PRP after the procedure.

What are the side effects of PRP?

PRP application does not have any negative side effects or complications as it is prepared from the patients’ own blood. If it is applied under sterile conditions, it does not carry any risk of infection. Likewise, there is no allergic reaction since patients have their own plasma.

Can drugs used for ED treatment be taken during PRP treatment?

There is no obstacle to taking known drugs together during PRP treatment due to erectile dysfunction. Patients can also use drugs at the same time. In this way, synergistic effects of combined treatments may also occur.

Can PRP treatment be applied more than once?

Since PRP treatment is obtained from the patient’s own blood, it is a procedure that does not have serious side effects. Therefore, there is no harm in repeating it at different times. It is recommended to repeat a single dose at 3, 6 and 12 months.

Is PRP treatment painful?

Platelets release many chemicals that attract or summon other reparative cells to the injury site. When platelets release their chemicals, it causes an inflammatory response. This causes pain during the procedure. For this reason, local painkillers or creams can be used during application, especially in patients with low pain threshold. Apart from this, there is no need for serious painkillers.

Does PRP application make penis length and diameter elongation and enlargement?

Although it is claimed that PPRP application will cause lengthening and enlargement of the penis in diameter, there is no significant change in penis length and diameter in practice. For this reason, it is not correct to consider the P-shot application as an alternative to penis lengthening and thickening surgeries.

How long after PRP application is sexual intercourse?

P-shot is not an invasive procedure. It does not cause severe pain and swelling (edema) or hematoma in the penis. Therefore, there is no need for sexual abstinence for a long time after the application. The patient can have intercourse at any time.

What do scientific studies say about PRP treatment?

Many urologists apply PRP treatment in patients with erectile dysfunction and claim that it is beneficial, but there is not much scientific data to support this idea.

When human and animal studies were examined, no adverse serious side effects of PRP treatment were reported.

Studies on PRP are studies conducted on a small number of patients without adequate comparison groups.

In summary: Researchers suggest that PRP has the potential to be a useful treatment option for ED. However, studies have yet to have small sample sizes and insufficient comparison groups. The available evidence is mostly anecdotal. Since the plasma prepared from the patient’s own blood is given to the patient, there are no side effects or complications. It is suggested that if used in combination with other treatments, they may increase their effects. Further studies with larger numbers of patients are needed so that the routine can be recommended to every patient. Patients should not expect miracles and neglect other classical treatment methods.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY